401k Plan data: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN plan

BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 401k Plan overview

Plan Name	BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN
Plan identification number	001

BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

BRIAN P. SCHAEFER, D.D.S., S.C. has sponsored the creation of one or more 401k plans.

Company Name: BRIAN P. SCHAEFER, D.D.S., S.C.

Employer identification number (EIN): 391822324

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-11-01 BRIAN P. SCHAEFER 2023-07-31
001 2020-11-01 BRIAN P. SCHAEFER 2021-10-31
001 2019-11-01 BRIAN P. SCHAEFER 2021-03-12
001 2018-11-01 BRIAN P. SCHAEFER 2020-07-02
001 2017-11-01 BRIAN P. SCHAEFER 2019-04-26
001 2016-11-01
001 2015-11-01
001 2014-11-01
001 2013-11-01 BRIAN P. SCHAEFER
001 2012-11-01 BRIAN P. SCHAEFER
001 2011-11-01 BRIAN P. SCHAEFER
001 2010-11-01 BRIAN P. SCHAEFER
001 2009-11-01 BRIAN P. SCHAEFER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-11-01	BRIAN P. SCHAEFER	2023-07-31
001	2020-11-01	BRIAN P. SCHAEFER	2021-10-31
001	2019-11-01	BRIAN P. SCHAEFER	2021-03-12
001	2018-11-01	BRIAN P. SCHAEFER	2020-07-02
001	2017-11-01	BRIAN P. SCHAEFER	2019-04-26
001	2016-11-01
001	2015-11-01
001	2014-11-01
001	2013-11-01	BRIAN P. SCHAEFER
001	2012-11-01	BRIAN P. SCHAEFER
001	2011-11-01	BRIAN P. SCHAEFER
001	2010-11-01	BRIAN P. SCHAEFER
001	2009-11-01	BRIAN P. SCHAEFER

Plan Statistics for BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN

401k plan membership statisitcs for BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN

Measure Date Value
2021: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-11-01 12
Total number of active participants reported on line 7a of the Form 5500 2021-11-01 9
Number of retired or separated participants receiving benefits 2021-11-01 0
Number of other retired or separated participants entitled to future benefits 2021-11-01 3
Total of all active and inactive participants 2021-11-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-11-01 0
Total participants 2021-11-01 12
Number of participants with account balances 2021-11-01 12
2020: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-11-01 12
Total number of active participants reported on line 7a of the Form 5500 2020-11-01 10
Number of retired or separated participants receiving benefits 2020-11-01 0
Number of other retired or separated participants entitled to future benefits 2020-11-01 0
Total of all active and inactive participants 2020-11-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-11-01 0
Total participants 2020-11-01 10
Number of participants with account balances 2020-11-01 10
2019: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-11-01 16
Total number of active participants reported on line 7a of the Form 5500 2019-11-01 11
Number of retired or separated participants receiving benefits 2019-11-01 0
Number of other retired or separated participants entitled to future benefits 2019-11-01 1
Total of all active and inactive participants 2019-11-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-11-01 0
Total participants 2019-11-01 12
Number of participants with account balances 2019-11-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-11-01 0
2018: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-11-01 7
Total number of active participants reported on line 7a of the Form 5500 2018-11-01 9
Number of retired or separated participants receiving benefits 2018-11-01 0
Number of other retired or separated participants entitled to future benefits 2018-11-01 1
Total of all active and inactive participants 2018-11-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-11-01 0
Total participants 2018-11-01 10
Number of participants with account balances 2018-11-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-11-01 0
2017: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-11-01 8
Total number of active participants reported on line 7a of the Form 5500 2017-11-01 4
Number of retired or separated participants receiving benefits 2017-11-01 0
Number of other retired or separated participants entitled to future benefits 2017-11-01 2
Total of all active and inactive participants 2017-11-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-11-01 0
Total participants 2017-11-01 6
Number of participants with account balances 2017-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-11-01 0
2016: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-11-01 12
Total number of active participants reported on line 7a of the Form 5500 2016-11-01 5
Number of retired or separated participants receiving benefits 2016-11-01 1
Number of other retired or separated participants entitled to future benefits 2016-11-01 1
Total of all active and inactive participants 2016-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-11-01 0
Total participants 2016-11-01 7
Number of participants with account balances 2016-11-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-11-01 0
2015: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-11-01 7
Total number of active participants reported on line 7a of the Form 5500 2015-11-01 6
Number of retired or separated participants receiving benefits 2015-11-01 6
Number of other retired or separated participants entitled to future benefits 2015-11-01 0
Total of all active and inactive participants 2015-11-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-11-01 0
Total participants 2015-11-01 12
Number of participants with account balances 2015-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-11-01 0
2014: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-11-01 8
Total number of active participants reported on line 7a of the Form 5500 2014-11-01 7
Number of retired or separated participants receiving benefits 2014-11-01 0
Number of other retired or separated participants entitled to future benefits 2014-11-01 0
Total of all active and inactive participants 2014-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-11-01 0
Total participants 2014-11-01 7
Number of participants with account balances 2014-11-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-11-01 0
2013: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-11-01 8
Total number of active participants reported on line 7a of the Form 5500 2013-11-01 8
Number of retired or separated participants receiving benefits 2013-11-01 0
Number of other retired or separated participants entitled to future benefits 2013-11-01 0
Total of all active and inactive participants 2013-11-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-11-01 0
Total participants 2013-11-01 8
Number of participants with account balances 2013-11-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-11-01 0
2012: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-11-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-11-01 6
Number of retired or separated participants receiving benefits 2012-11-01 0
Number of other retired or separated participants entitled to future benefits 2012-11-01 1
Total of all active and inactive participants 2012-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-11-01 0
Total participants 2012-11-01 7
Number of participants with account balances 2012-11-01 7
2011: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-11-01 7
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 5
Number of retired or separated participants receiving benefits 2011-11-01 0
Number of other retired or separated participants entitled to future benefits 2011-11-01 2
Total of all active and inactive participants 2011-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-11-01 0
Total participants 2011-11-01 7
Number of participants with account balances 2011-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-11-01 0
2010: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-11-01 7
Total number of active participants reported on line 7a of the Form 5500 2010-11-01 6
Number of other retired or separated participants entitled to future benefits 2010-11-01 1
Total of all active and inactive participants 2010-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-11-01 0
Total participants 2010-11-01 7
Number of participants with account balances 2010-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-11-01 0
2009: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-11-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-11-01 7
Number of retired or separated participants receiving benefits 2009-11-01 0
Number of other retired or separated participants entitled to future benefits 2009-11-01 0
Total of all active and inactive participants 2009-11-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-11-01 0
Total participants 2009-11-01 7
Number of participants with account balances 2009-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-11-01 0

Measure	Date	Value
2021: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-11-01	12
Total number of active participants reported on line 7a of the Form 5500	2021-11-01	9
Number of retired or separated participants receiving benefits	2021-11-01	0
Number of other retired or separated participants entitled to future benefits	2021-11-01	3
Total of all active and inactive participants	2021-11-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-11-01	0
Total participants	2021-11-01	12
Number of participants with account balances	2021-11-01	12
2020: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-11-01	12
Total number of active participants reported on line 7a of the Form 5500	2020-11-01	10
Number of retired or separated participants receiving benefits	2020-11-01	0
Number of other retired or separated participants entitled to future benefits	2020-11-01	0
Total of all active and inactive participants	2020-11-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-11-01	0
Total participants	2020-11-01	10
Number of participants with account balances	2020-11-01	10
2019: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-11-01	16
Total number of active participants reported on line 7a of the Form 5500	2019-11-01	11
Number of retired or separated participants receiving benefits	2019-11-01	0
Number of other retired or separated participants entitled to future benefits	2019-11-01	1
Total of all active and inactive participants	2019-11-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-11-01	0
Total participants	2019-11-01	12
Number of participants with account balances	2019-11-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-11-01	0
2018: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-11-01	7
Total number of active participants reported on line 7a of the Form 5500	2018-11-01	9
Number of retired or separated participants receiving benefits	2018-11-01	0
Number of other retired or separated participants entitled to future benefits	2018-11-01	1
Total of all active and inactive participants	2018-11-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-11-01	0
Total participants	2018-11-01	10
Number of participants with account balances	2018-11-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-11-01	0
2017: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-11-01	8
Total number of active participants reported on line 7a of the Form 5500	2017-11-01	4
Number of retired or separated participants receiving benefits	2017-11-01	0
Number of other retired or separated participants entitled to future benefits	2017-11-01	2
Total of all active and inactive participants	2017-11-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-11-01	0
Total participants	2017-11-01	6
Number of participants with account balances	2017-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-11-01	0
2016: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-11-01	12
Total number of active participants reported on line 7a of the Form 5500	2016-11-01	5
Number of retired or separated participants receiving benefits	2016-11-01	1
Number of other retired or separated participants entitled to future benefits	2016-11-01	1
Total of all active and inactive participants	2016-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-11-01	0
Total participants	2016-11-01	7
Number of participants with account balances	2016-11-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-11-01	0
2015: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-11-01	7
Total number of active participants reported on line 7a of the Form 5500	2015-11-01	6
Number of retired or separated participants receiving benefits	2015-11-01	6
Number of other retired or separated participants entitled to future benefits	2015-11-01	0
Total of all active and inactive participants	2015-11-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-11-01	0
Total participants	2015-11-01	12
Number of participants with account balances	2015-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-11-01	0
2014: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-11-01	8
Total number of active participants reported on line 7a of the Form 5500	2014-11-01	7
Number of retired or separated participants receiving benefits	2014-11-01	0
Number of other retired or separated participants entitled to future benefits	2014-11-01	0
Total of all active and inactive participants	2014-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-11-01	0
Total participants	2014-11-01	7
Number of participants with account balances	2014-11-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-11-01	0
2013: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-11-01	8
Total number of active participants reported on line 7a of the Form 5500	2013-11-01	8
Number of retired or separated participants receiving benefits	2013-11-01	0
Number of other retired or separated participants entitled to future benefits	2013-11-01	0
Total of all active and inactive participants	2013-11-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-11-01	0
Total participants	2013-11-01	8
Number of participants with account balances	2013-11-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-11-01	0
2012: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-11-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-11-01	6
Number of retired or separated participants receiving benefits	2012-11-01	0
Number of other retired or separated participants entitled to future benefits	2012-11-01	1
Total of all active and inactive participants	2012-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-11-01	0
Total participants	2012-11-01	7
Number of participants with account balances	2012-11-01	7
2011: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-11-01	7
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	5
Number of retired or separated participants receiving benefits	2011-11-01	0
Number of other retired or separated participants entitled to future benefits	2011-11-01	2
Total of all active and inactive participants	2011-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-11-01	0
Total participants	2011-11-01	7
Number of participants with account balances	2011-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-11-01	0
2010: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-11-01	7
Total number of active participants reported on line 7a of the Form 5500	2010-11-01	6
Number of other retired or separated participants entitled to future benefits	2010-11-01	1
Total of all active and inactive participants	2010-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-11-01	0
Total participants	2010-11-01	7
Number of participants with account balances	2010-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-11-01	0
2009: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-11-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-11-01	7
Number of retired or separated participants receiving benefits	2009-11-01	0
Number of other retired or separated participants entitled to future benefits	2009-11-01	0
Total of all active and inactive participants	2009-11-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-11-01	0
Total participants	2009-11-01	7
Number of participants with account balances	2009-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-11-01	0

Financial Data on BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN

Measure	Date	Value
2022 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2022 401k financial data
Total income from all sources	2022-10-31	$-424,859
Expenses. Total of all expenses incurred	2022-10-31	$14,781
Benefits paid (including direct rollovers)	2022-10-31	$14,781
Total plan assets at end of year	2022-10-31	$3,368,716
Total plan assets at beginning of year	2022-10-31	$3,808,356
Value of fidelity bond covering the plan	2022-10-31	$300,000
Total contributions received or receivable from participants	2022-10-31	$112,965
Contributions received from other sources (not participants or employers)	2022-10-31	$2,812
Noncash contributions received	2022-10-31	$-661,354
Net income (gross income less expenses)	2022-10-31	$-439,640
Net plan assets at end of year (total assets less liabilities)	2022-10-31	$3,368,716
Net plan assets at beginning of year (total assets less liabilities)	2022-10-31	$3,808,356
Assets. Value of participant loans	2022-10-31	$3,647
Assets. Value of assets in partnership/joint-venture interests	2022-10-31	$119,315
Total contributions received or receivable from employer(s)	2022-10-31	$120,718
2021 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2021 401k financial data
Total income from all sources	2021-10-31	$992,611
Expenses. Total of all expenses incurred	2021-10-31	$741,323
Benefits paid (including direct rollovers)	2021-10-31	$717,104
Total plan assets at end of year	2021-10-31	$3,808,356
Total plan assets at beginning of year	2021-10-31	$3,557,068
Value of fidelity bond covering the plan	2021-10-31	$300,000
Total contributions received or receivable from participants	2021-10-31	$124,406
Other income received	2021-10-31	$789,545
Net income (gross income less expenses)	2021-10-31	$251,288
Net plan assets at end of year (total assets less liabilities)	2021-10-31	$3,808,356
Net plan assets at beginning of year (total assets less liabilities)	2021-10-31	$3,557,068
Assets. Value of participant loans	2021-10-31	$5,974
Assets. Value of assets in partnership/joint-venture interests	2021-10-31	$111,363
Total contributions received or receivable from employer(s)	2021-10-31	$78,660
Expenses. Administrative service providers (salaries,fees and commissions)	2021-10-31	$24,219
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-10-31	$0
2020 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2020 401k financial data
Total income from all sources	2020-10-31	$413,179
Expenses. Total of all expenses incurred	2020-10-31	$20,286
Benefits paid (including direct rollovers)	2020-10-31	$437
Total plan assets at end of year	2020-10-31	$3,557,068
Total plan assets at beginning of year	2020-10-31	$3,164,175
Value of fidelity bond covering the plan	2020-10-31	$300,000
Total contributions received or receivable from participants	2020-10-31	$95,228
Contributions received from other sources (not participants or employers)	2020-10-31	$39,060
Other income received	2020-10-31	$214,177
Net income (gross income less expenses)	2020-10-31	$392,893
Net plan assets at end of year (total assets less liabilities)	2020-10-31	$3,557,068
Net plan assets at beginning of year (total assets less liabilities)	2020-10-31	$3,164,175
Assets. Value of participant loans	2020-10-31	$8,975
Assets. Value of assets in partnership/joint-venture interests	2020-10-31	$145,520
Total contributions received or receivable from employer(s)	2020-10-31	$64,714
Expenses. Administrative service providers (salaries,fees and commissions)	2020-10-31	$19,849
2019 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2019 401k financial data
Total income from all sources	2019-10-31	$442,534
Expenses. Total of all expenses incurred	2019-10-31	$39,693
Benefits paid (including direct rollovers)	2019-10-31	$20,289
Total plan assets at end of year	2019-10-31	$3,164,175
Total plan assets at beginning of year	2019-10-31	$2,761,334
Value of fidelity bond covering the plan	2019-10-31	$300,000
Total contributions received or receivable from participants	2019-10-31	$76,778
Contributions received from other sources (not participants or employers)	2019-10-31	$19,584
Other income received	2019-10-31	$291,599
Net income (gross income less expenses)	2019-10-31	$402,841
Net plan assets at end of year (total assets less liabilities)	2019-10-31	$3,164,175
Net plan assets at beginning of year (total assets less liabilities)	2019-10-31	$2,761,334
Assets. Value of participant loans	2019-10-31	$11,051
Assets. Value of assets in partnership/joint-venture interests	2019-10-31	$130,862
Total contributions received or receivable from employer(s)	2019-10-31	$54,573
Expenses. Administrative service providers (salaries,fees and commissions)	2019-10-31	$19,404
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-10-31	$0
2017 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2017 401k financial data
Total income from all sources	2017-10-31	$423,871
Expenses. Total of all expenses incurred	2017-10-31	$23,634
Benefits paid (including direct rollovers)	2017-10-31	$11,330
Total plan assets at end of year	2017-10-31	$2,626,983
Total plan assets at beginning of year	2017-10-31	$2,226,746
Value of fidelity bond covering the plan	2017-10-31	$245,000
Total contributions received or receivable from participants	2017-10-31	$75,541
Other income received	2017-10-31	$294,626
Net income (gross income less expenses)	2017-10-31	$400,237
Net plan assets at end of year (total assets less liabilities)	2017-10-31	$2,626,983
Net plan assets at beginning of year (total assets less liabilities)	2017-10-31	$2,226,746
Assets. Value of participant loans	2017-10-31	$7,398
Assets. Value of assets in partnership/joint-venture interests	2017-10-31	$110,630
Total contributions received or receivable from employer(s)	2017-10-31	$53,704
Expenses. Administrative service providers (salaries,fees and commissions)	2017-10-31	$12,304
2016 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2016 401k financial data
Total income from all sources	2016-10-31	$183,421
Expenses. Total of all expenses incurred	2016-10-31	$25,835
Benefits paid (including direct rollovers)	2016-10-31	$15,100
Total plan assets at end of year	2016-10-31	$2,226,746
Total plan assets at beginning of year	2016-10-31	$2,069,160
Value of fidelity bond covering the plan	2016-10-31	$245,000
Total contributions received or receivable from participants	2016-10-31	$75,671
Other income received	2016-10-31	$52,503
Net income (gross income less expenses)	2016-10-31	$157,586
Net plan assets at end of year (total assets less liabilities)	2016-10-31	$2,226,746
Net plan assets at beginning of year (total assets less liabilities)	2016-10-31	$2,069,160
Assets. Value of participant loans	2016-10-31	$10,784
Assets. Value of assets in partnership/joint-venture interests	2016-10-31	$135,769
Total contributions received or receivable from employer(s)	2016-10-31	$55,247
Expenses. Administrative service providers (salaries,fees and commissions)	2016-10-31	$10,735
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-10-31	$0
2015 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-10-31	$160,912
Expenses. Total of all expenses incurred	2015-10-31	$13,317
Total plan assets at end of year	2015-10-31	$2,069,160
Total plan assets at beginning of year	2015-10-31	$1,921,565
Value of fidelity bond covering the plan	2015-10-31	$220,000
Total contributions received or receivable from participants	2015-10-31	$90,876
Contributions received from other sources (not participants or employers)	2015-10-31	$0
Other income received	2015-10-31	$10,374
Net income (gross income less expenses)	2015-10-31	$147,595
Net plan assets at end of year (total assets less liabilities)	2015-10-31	$2,069,160
Net plan assets at beginning of year (total assets less liabilities)	2015-10-31	$1,921,565
Assets. Value of participant loans	2015-10-31	$14,424
Assets. Value of assets in partnership/joint-venture interests	2015-10-31	$140,509
Total contributions received or receivable from employer(s)	2015-10-31	$59,662
Expenses. Administrative service providers (salaries,fees and commissions)	2015-10-31	$13,317
2014 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2014 401k financial data
Total income from all sources	2014-10-31	$224,731
Expenses. Total of all expenses incurred	2014-10-31	$74,460
Benefits paid (including direct rollovers)	2014-10-31	$61,825
Total plan assets at end of year	2014-10-31	$1,921,565
Total plan assets at beginning of year	2014-10-31	$1,771,294
Value of fidelity bond covering the plan	2014-10-31	$150,000
Total contributions received or receivable from participants	2014-10-31	$46,400
Contributions received from other sources (not participants or employers)	2014-10-31	$50,000
Other income received	2014-10-31	$113,202
Net income (gross income less expenses)	2014-10-31	$150,271
Net plan assets at end of year (total assets less liabilities)	2014-10-31	$1,921,565
Net plan assets at beginning of year (total assets less liabilities)	2014-10-31	$1,771,294
Assets. Value of participant loans	2014-10-31	$4,076
Assets. Value of assets in partnership/joint-venture interests	2014-10-31	$141,161
Total contributions received or receivable from employer(s)	2014-10-31	$15,129
Expenses. Administrative service providers (salaries,fees and commissions)	2014-10-31	$12,635
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-10-31	$0
2013 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-10-31	$281,891
Expenses. Total of all expenses incurred	2013-10-31	$11,343
Benefits paid (including direct rollovers)	2013-10-31	$9,394
Total plan assets at end of year	2013-10-31	$1,771,294
Total plan assets at beginning of year	2013-10-31	$1,500,746
Value of fidelity bond covering the plan	2013-10-31	$150,000
Total contributions received or receivable from participants	2013-10-31	$65,455
Other income received	2013-10-31	$167,258
Net income (gross income less expenses)	2013-10-31	$270,548
Net plan assets at end of year (total assets less liabilities)	2013-10-31	$1,771,294
Net plan assets at beginning of year (total assets less liabilities)	2013-10-31	$1,500,746
Assets. Value of participant loans	2013-10-31	$5,543
Assets. Value of assets in partnership/joint-venture interests	2013-10-31	$133,931
Total contributions received or receivable from employer(s)	2013-10-31	$49,178
Expenses. Administrative service providers (salaries,fees and commissions)	2013-10-31	$1,949
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-10-31	$0
2012 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-10-31	$164,556
Expenses. Total of all expenses incurred	2012-10-31	$1,690
Total plan assets at end of year	2012-10-31	$1,500,746
Total plan assets at beginning of year	2012-10-31	$1,337,880
Value of fidelity bond covering the plan	2012-10-31	$150,000
Total contributions received or receivable from participants	2012-10-31	$52,139
Other income received	2012-10-31	$64,919
Net income (gross income less expenses)	2012-10-31	$162,866
Net plan assets at end of year (total assets less liabilities)	2012-10-31	$1,500,746
Net plan assets at beginning of year (total assets less liabilities)	2012-10-31	$1,337,880
Assets. Value of assets in partnership/joint-venture interests	2012-10-31	$134,952
Total contributions received or receivable from employer(s)	2012-10-31	$47,498
Expenses. Administrative service providers (salaries,fees and commissions)	2012-10-31	$1,690
2011 : BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-10-31	$108,461
Expenses. Total of all expenses incurred	2011-10-31	$51,509
Benefits paid (including direct rollovers)	2011-10-31	$50,000
Total plan assets at end of year	2011-10-31	$1,337,880
Total plan assets at beginning of year	2011-10-31	$1,280,928
Value of fidelity bond covering the plan	2011-10-31	$150,000
Total contributions received or receivable from participants	2011-10-31	$62,474
Other income received	2011-10-31	$-4,982
Net income (gross income less expenses)	2011-10-31	$56,952
Net plan assets at end of year (total assets less liabilities)	2011-10-31	$1,337,880
Net plan assets at beginning of year (total assets less liabilities)	2011-10-31	$1,280,928
Assets. Value of assets in partnership/joint-venture interests	2011-10-31	$129,165
Total contributions received or receivable from employer(s)	2011-10-31	$50,969
Expenses. Administrative service providers (salaries,fees and commissions)	2011-10-31	$1,509
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-10-31	$0

Form 5500 Responses for BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN

2021: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2021 form 5500 responses
2021-11-01	Type of plan entity	Single employer plan
2021-11-01	Submission has been amended	No
2021-11-01	This submission is the final filing	No
2021-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-11-01	Plan is a collectively bargained plan	No
2021-11-01	Plan funding arrangement – Insurance	Yes
2021-11-01	Plan funding arrangement – Trust	Yes
2021-11-01	Plan benefit arrangement – Insurance	Yes
2021-11-01	Plan benefit arrangement - Trust	Yes
2020: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2020 form 5500 responses
2020-11-01	Type of plan entity	Single employer plan
2020-11-01	Submission has been amended	No
2020-11-01	This submission is the final filing	No
2020-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-11-01	Plan is a collectively bargained plan	No
2020-11-01	Plan funding arrangement – Insurance	Yes
2020-11-01	Plan funding arrangement – Trust	Yes
2020-11-01	Plan benefit arrangement – Insurance	Yes
2020-11-01	Plan benefit arrangement - Trust	Yes
2019: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2019 form 5500 responses
2019-11-01	Type of plan entity	Single employer plan
2019-11-01	Submission has been amended	No
2019-11-01	This submission is the final filing	No
2019-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-11-01	Plan is a collectively bargained plan	No
2019-11-01	Plan funding arrangement – Insurance	Yes
2019-11-01	Plan funding arrangement – Trust	Yes
2019-11-01	Plan benefit arrangement – Insurance	Yes
2019-11-01	Plan benefit arrangement - Trust	Yes
2018: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2018 form 5500 responses
2018-11-01	Type of plan entity	Single employer plan
2018-11-01	Submission has been amended	No
2018-11-01	This submission is the final filing	No
2018-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-11-01	Plan is a collectively bargained plan	No
2018-11-01	Plan funding arrangement – Insurance	Yes
2018-11-01	Plan funding arrangement – Trust	Yes
2018-11-01	Plan benefit arrangement – Insurance	Yes
2018-11-01	Plan benefit arrangement - Trust	Yes
2017: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2017 form 5500 responses
2017-11-01	Type of plan entity	Single employer plan
2017-11-01	Submission has been amended	No
2017-11-01	This submission is the final filing	No
2017-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-11-01	Plan is a collectively bargained plan	No
2017-11-01	Plan funding arrangement – Insurance	Yes
2017-11-01	Plan funding arrangement – Trust	Yes
2017-11-01	Plan benefit arrangement – Insurance	Yes
2017-11-01	Plan benefit arrangement - Trust	Yes
2016: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2016 form 5500 responses
2016-11-01	Type of plan entity	Single employer plan
2016-11-01	Submission has been amended	No
2016-11-01	This submission is the final filing	No
2016-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-11-01	Plan is a collectively bargained plan	No
2016-11-01	Plan funding arrangement – Insurance	Yes
2016-11-01	Plan funding arrangement – Trust	Yes
2016-11-01	Plan benefit arrangement – Insurance	Yes
2016-11-01	Plan benefit arrangement - Trust	Yes
2015: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2015 form 5500 responses
2015-11-01	Type of plan entity	Single employer plan
2015-11-01	Submission has been amended	No
2015-11-01	This submission is the final filing	No
2015-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-11-01	Plan is a collectively bargained plan	No
2015-11-01	Plan funding arrangement – Insurance	Yes
2015-11-01	Plan funding arrangement – Trust	Yes
2015-11-01	Plan benefit arrangement – Insurance	Yes
2015-11-01	Plan benefit arrangement - Trust	Yes
2014: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2014 form 5500 responses
2014-11-01	Type of plan entity	Single employer plan
2014-11-01	Submission has been amended	No
2014-11-01	This submission is the final filing	No
2014-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-11-01	Plan is a collectively bargained plan	No
2014-11-01	Plan funding arrangement – Insurance	Yes
2014-11-01	Plan funding arrangement – Trust	Yes
2014-11-01	Plan benefit arrangement – Insurance	Yes
2014-11-01	Plan benefit arrangement - Trust	Yes
2013: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2013 form 5500 responses
2013-11-01	Type of plan entity	Single employer plan
2013-11-01	Submission has been amended	No
2013-11-01	This submission is the final filing	No
2013-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-11-01	Plan is a collectively bargained plan	No
2013-11-01	Plan funding arrangement – Insurance	Yes
2013-11-01	Plan funding arrangement – Trust	Yes
2013-11-01	Plan benefit arrangement – Insurance	Yes
2013-11-01	Plan benefit arrangement - Trust	Yes
2012: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2012 form 5500 responses
2012-11-01	Type of plan entity	Single employer plan
2012-11-01	Submission has been amended	No
2012-11-01	This submission is the final filing	No
2012-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-11-01	Plan is a collectively bargained plan	No
2012-11-01	Plan funding arrangement – Insurance	Yes
2012-11-01	Plan funding arrangement – Trust	Yes
2012-11-01	Plan benefit arrangement – Insurance	Yes
2012-11-01	Plan benefit arrangement - Trust	Yes
2011: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	Submission has been amended	No
2011-11-01	This submission is the final filing	No
2011-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-11-01	Plan is a collectively bargained plan	No
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan funding arrangement – Trust	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement - Trust	Yes
2010: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2010 form 5500 responses
2010-11-01	Type of plan entity	Single employer plan
2010-11-01	Submission has been amended	No
2010-11-01	This submission is the final filing	No
2010-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-11-01	Plan is a collectively bargained plan	No
2010-11-01	Plan funding arrangement – Insurance	Yes
2010-11-01	Plan funding arrangement – Trust	Yes
2010-11-01	Plan benefit arrangement – Insurance	Yes
2010-11-01	Plan benefit arrangement - Trust	Yes
2009: BRIAN P. SCHAEFER, D.D.S., S.C. PROFIT SHARING 401(K) PLAN 2009 form 5500 responses
2009-11-01	Type of plan entity	Single employer plan
2009-11-01	Submission has been amended	No
2009-11-01	This submission is the final filing	No
2009-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-11-01	Plan is a collectively bargained plan	No
2009-11-01	Plan funding arrangement – Insurance	Yes
2009-11-01	Plan funding arrangement – Trust	Yes
2009-11-01	Plan benefit arrangement – Insurance	Yes
2009-11-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	8
Insurance policy start date	2017-11-01
Insurance policy end date	2018-10-31
Total amount of commissions paid to insurance broker	USD $1,156
Total amount of fees paid to insurance company	USD $146
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	7
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $2,236
Total amount of fees paid to insurance company	USD $280
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,236
Insurance broker organization code?	3
Amount paid for insurance broker fees	280
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	8
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $2,075
Total amount of fees paid to insurance company	USD $241
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,739
Insurance broker organization code?	3
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	RETIREMENT STRATEGIES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	7
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $1,548
Total amount of fees paid to insurance company	USD $195
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,548
Insurance broker organization code?	3
Amount paid for insurance broker fees	195
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	RETIREMENT STRATEGIES, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	7
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $1,310
Total amount of fees paid to insurance company	USD $164
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

95271

Policy instance

Insurance contract or identification number	95271
Number of Individuals Covered	7
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $1,463
Total amount of fees paid to insurance company	USD $141
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	BRIAN P. SCHAEFER, D.D.S., S.C.
Employer identification number (EIN):	391822324
NAIC Classification:	621210
NAIC Description:	Offices of Dentists